TY - JOUR
T1 - Guidelines for endoscopic balloon dilation in treating Crohn's disease-associated small intestinal strictures (supplement to the Clinical Practice Guidelines for Enteroscopy)
AU - Yamamoto, Hironori
AU - Yano, Tomonori
AU - Araki, Akihiro
AU - Esaki, Motohiro
AU - Ohtsuka, Kazuo
AU - Ohmiya, Naoki
AU - Oka, Shiro
AU - Nakase, Hiroshi
AU - Bamba, Shigeki
AU - Hirai, Fumihito
AU - Hosoe, Naoki
AU - Matsuda, Tomoki
AU - Mitsui, Keigo
AU - Watanabe, Kenji
AU - Ogata, Haruhiko
AU - Katsuki, Shinichi
AU - Matsumoto, Takayuki
AU - Fujishiro, Mitsuhiro
AU - Fujimoto, Kazuma
AU - Inoue, Haruhiro
N1 - Funding Information:
The Japan Gastroenterological Endoscopy Society covered expenses related to development of these Guidelines. Crohn's disease, a chronic inflammatory bowel disease (IBD), is characterized by transmural inflammation in the gastrointestinal (GI) tract and may lead to discontinuous deep ulcers. Repeated cycles of recurrence and remission of Crohn's disease may cause strictures, fistulas, or perforations in the GI tract. Advanced GI tract strictures may result in intestinal obstruction, inhibiting oral intake. In the past, it was difficult to reach the site of small intestinal strictures with an endoscope, and intestinal resection and/or stricture-plasty were commonly performed surgically. However, surgical treatment cannot completely cure Crohn's disease, and repeated surgical resections for recurrent strictures increase the risk of developing short bowel syndrome, particularly in cases where multiple strictures are distributed over long segments of the small intestine and require more extensive resections. Introduction of balloon-assisted enteroscopy (BAE) has enabled endoscopic treatments, including endoscopic balloon dilation (EBD), in the deeper segments of the small bowel. EBD has recently been widely recognized as a minimally invasive treatment for Crohn's disease-associated small intestinal strictures; however, guidelines for a standard EBD procedure have not been established. In 2015, the Japan Gastroenterological Endoscopy Society (JGES) developed the Clinical Practice Guidelines for Enteroscopy.1 Although these guidelines described the indications for EBD, detailed EBD methodology was not mentioned. Therefore, the committee was asked to develop “Guidelines for endoscopic balloon dilation in treating Crohn's disease-associated small intestinal strictures” as an addendum to the Clinical Practice Guidelines. A motorized-spiral enteroscope (PowerSpiral; Olympus, Tokyo, Japan) was approved in Japan in 2021; however, sufficient evidence is lacking at present regarding its efficacy and safety for treating small intestinal strictures or ulcers in patients with Crohn's disease, and hence, has been excluded from the new EBD guidelines. The guidelines were developed according to the Minds Handbook for Clinical Practice Guideline Development 20172 to ensure that they were rooted to evidence-based medicine (Table 1), and were written in the clinical questions (CQ) format. High-level evidence in this field is scarce, which necessitated relying on the consensus of experts. Nevertheless, we hope that the guidelines will be helpful for clinicians in the treatment of patients with Crohn's disease-associated small intestinal strictures.
Publisher Copyright:
© 2022 Japan Gastroenterological Endoscopy Society.
PY - 2022/11
Y1 - 2022/11
N2 - Balloon-assisted enteroscopy allows endoscopic treatments in the deeper segments of the small bowel. Endoscopic balloon dilation has become a popular minimally invasive alternative for the treatment of Crohn's disease-associated small intestinal strictures. As a supplement to the Clinical Practice Guidelines for Enteroscopy, the Japan Gastroenterological Endoscopy Society's Working Committee has developed the present “Guidelines for endoscopic balloon dilation in treating Crohn's disease-associated small intestinal strictures,” based on new scientific techniques and evidence. The guidelines cover standard procedures for the insertion route of the balloon endoscope, bowel preparation, indications, procedure-related complications, efficacy, target diameter and duration, management of multiple strictures, and the current state of combined and alternative treatments. Unresolved future research questions are also listed in this guideline.
AB - Balloon-assisted enteroscopy allows endoscopic treatments in the deeper segments of the small bowel. Endoscopic balloon dilation has become a popular minimally invasive alternative for the treatment of Crohn's disease-associated small intestinal strictures. As a supplement to the Clinical Practice Guidelines for Enteroscopy, the Japan Gastroenterological Endoscopy Society's Working Committee has developed the present “Guidelines for endoscopic balloon dilation in treating Crohn's disease-associated small intestinal strictures,” based on new scientific techniques and evidence. The guidelines cover standard procedures for the insertion route of the balloon endoscope, bowel preparation, indications, procedure-related complications, efficacy, target diameter and duration, management of multiple strictures, and the current state of combined and alternative treatments. Unresolved future research questions are also listed in this guideline.
KW - Crohn's disease
KW - balloon-assisted endoscopy
KW - endoscopic balloon dilation
KW - small intestinal stricture
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U2 - 10.1111/den.14429
DO - 10.1111/den.14429
M3 - Article
C2 - 36073310
AN - SCOPUS:85141893997
SN - 0915-5635
VL - 34
SP - 1278
EP - 1296
JO - Digestive Endoscopy
JF - Digestive Endoscopy
IS - 7
ER -